Hey everyone, it's nurse Mike here from simple nursing.com. Today we're breaking down diabetes malitis or what I like to call diet treaties, type 1 and type two and all the must know ENCLEX key points. So stick with me. I'm going to be sharing memory tricks to make this info really easy to lock in. And for my simple nursing members, be sure to grab these two study guides to follow along. You'll walk away feeling confident and ready to ace this exam. All right, ready to crush it? Let's get going. Since this blood is turned to mud from that thick sugar and over time this high sugar destroys the vital organs and blood vessels leading to kidney failure, nerve damage, blindness and even high blood pressure. Now to clarify DM is for diabetes malitis not for direct message. So guys it doesn't go down in the DM and it's not the same as diabetes incipitus guys. DI is a diaresing peeing problem, not a sugar problem. Now for pathobasics. As you know, blood sugar naturally increases when we eat. The pancreas releases insulin from the beta cells and also enzymes to help break down food for fuel. So remember, insulin puts sugar and potassium into the cell, making our hungry cells really happy. Now, when we give insulin, both sugar and potassium decrease in the blood since it's going into the cell. Now, if we don't have food, then the pancreas has a backup plan. It releases glucagon hormone to break down stored glucose aka glycogen in the liver which increases sugar in the blood. Glycogen is kind of like a glucose brick wall. So remember gluca gone means glucose gone out of the liver into the bloodstream which increases blood sugar. So again when blood sugar is high like after you eat insulin is released and when blood sugar is low like when you exercise or forget to eat glucagon is released. So in diabetes, insulin is the problem here, guys. Type one, we have none. Since the body has killed its own pancreas, it produces no insulin. And people are born with it. It's an autoimmune disease. So type one you can pass on to your son since it's genetical. And these patients are insulin dependent for life. Big key word. Now in type two, remember few insulin receptors work since the problem is you, your diet and lifestyle. the high in sugars and sitting seditary lifestyle. We're talking junk food like sodas, white breads, and sweets, which eventually leads to obesity and our cells now are lazy and overused. The insulin receptor sites are like an overused keyhole. They basically been worn out and now just ignore the insulin. This is called insulin resistance. So just think in type two, the cells are through. They quit responding. Now, the risk factors for developing diabetes, guys, in type one, there are none. Since it's mostly genetical, you can pass it on to your son. And in type two, the problem is you, your diet and a little bit of genetics. So, we screen for metabolic syndrome, which increases the risk of not only diabetes, but also heart disease and stroke. Now, this is big on exams in the ENCLEX. So, we use the acronym BOL for metabolic syndrome. So guys, three or more criteria means we have metabolic syndrome. So B for blood pressure meds and high BP over 130 systolic. Our next B is for blood sugar medications or high blood sugar over key word here guys. Write this down 100 fasting over 100 fasting. O is for obesity. Big key words here guys. Waist size over 35 for females and over 45 for males. And lastly L is for lipids that are high. This is not good. We're talking high cholesterol panel. Write these numbers down. 200, 150, and 100. All should be low except the HDLs are happy lipids. That one should be over 40. Now guys, if these numbers are off, it could mean metabolic syndrome. And this contributes to insulin resistance in type two where the cells are through again like an overuse lock. The cells stop responding from the overuse of insulin. Now, I can already see questions coming up on your exam and enclelex. So, I recommend writing this bowl memory trick out at least 15 times the week of your exam. Now, to help you, here's a common practice question. Which clients are most at risk for developing metabolic syndrome? A 35-year-old male with triglycerides of 140? Nope, guys. The triglycerides are under 150, so that's okay. How about option number two? 48-year-old female with a fasting blood glucose of 105. Guys, yes, fasting sugars over 100, metabolic syndrome. Option three, 55year-old female with a waist size of 40 in. Oh yes, over 35 waist. And a 28-year-old male with a blood pressure of 135 over 85. Guys, yes, the systolic pressure is over 30. Lastly, a 42-year-old female with high HDLs of 55. Guys, know those are the only lipids that should be high over 140. Just think the high lipids for HDL. If you want to master questions just like these, our simple nursing membership has exit prep lectures and thousands of practice questions, all crafted by current professors and enclelex writers. Now, speaking of type two, technically not a cause, but a very particular sign of insulin resistance. Key word, write this down. brownish or dark thickening on the neck and armpits or even hyperpigmentation and skin tags. This is what's called athosis nigricans. Now, as far as diagnosing diabetes, the top three must know labs for the enlex that you will get tested on. Guys, write these down. Number one, normal glucose must be 70 to 115. Number two, fasting glucose less than 100. And third, hemoglobin A1C must be less than 6.5. Those are big enlex key numbers there. Write those down. Now, as you know, the A1C test is our long 2 to 3 month sugar audit and it's best used to see if patients are being compliant with controlling their blood sugars the long term. So remember, below six is controlled and fixed. And over 6.5, we got to revise. So review diet and exercise compliance for our type two problem. Basically the U problem and with type one insulin compliance always on the ENLEX. Now the most deadly is low sugar under 70 called hypoglycemia since it causes brain death. So we say hypogly the brain will die. Now all the other numbers on this chart just help diagnose the severity of diabetes but are not highly tested on the ENLEX. And speaking of something that's not highly tested, a little side note here. The GTT or glucose tolerance test is when we give an 8 oz drink of syrupy glucose to see if insulin is doing its job by putting the sugar into the cell. If it's not, then the sugar will go high. But guys, that's not usually tested on the ENLEX directly. Now, signs and symptoms and causes of high sugar or hypoglycemia. Just think the blood is turned to mud. So the body tries to get rid of all this thick syrup with the three Ps. First P for polyurea, a lot of urine. Basically the body tries to urinate it out. Now polyypipssia is a lot of drinking fluid. The body tries to dilute all that sugar. Now third is polyphasia which is excess hunger as cells starve since insulin's not doing its job to get sugar inside the cells. Now a little side note, this is not polyphasia which is a psych disorder. Now the causes of acute high sugar can be caused from the four S's. The number one key term on the ENLEX is sepsis or infection guys. That's a number one cause. But also stress from surgery or hospital stay and even skipping insulin doses. And a big one here is steroids. Those zone ending drugs like predinazone. That is a big cause. But high sugar can also be caused from hormone therapy like estrogen. Now, we treat that high sugar with insulin to put that sugar into the cells. So, for your test, I know that's going to come up. Yes, we increase the insulin during stress like sepsis, surgery, and especially with steroids. And guys, no, the patient's not on insulin forever. Once the S's stop, then the insulin stops. And guys, big key word here, if the sugar is still high after the insulin, that's a critical situation. always call the doctor or HCP. Now on the other side for hypoglycemia that low sugar below 70 guys just think low brain function which leads to rapid brain death. So remember hypogly the brain will die. We're going to be watching for critical signs the cool pale sweaty or clammy. We need to give that patient some sugary candy. Now typical enclelex keywords include high wash. So headache, irritability, weakness or anxiety, and even shakiness and hunger. It's kind of like a Snickers commercial. You're just not you when you're hungry. Now since hypo is so deadly that hypogly is giving sugar. So on the enclelex if the patient is awake, then we a ask them to eat specifically juice, soda, crackers, and low-fat milk, not high milk or peanut butter. Big key word right there. The fat actually slows down the sugar absorption. And if they're asleep, big key word here is not alert or unarousable or only arousable to painful stimuli. Then we s stab them with dextrose IV. And always reassess sugars every 15 minutes after giving insulin. Now causes of hypoglycemia. They usually come from exercise, alcohol, and even insulin peak times. Big Enclelex tip right there. So, watch out for diabetic athletes who exercise. If your patients exercise, then give extra glucose. Keywords, bicyclists, swimmers, and even runners. Now, alcohol is also a big no no technically with any disease, but it actually lowers sugar, doesn't increase it. And insulin peak times is when patients are most at risk for that low sugar. So, remember, if there's a peak time, then we give a plate of food. Since hypogly the brain will die. Now three common test questions for that low or high sugar. Here we go. Test question number one. A client with type 1 diabetes is only responsive to painful stimuli with a blood sugar of 42. What's the first action taken by the nurse? Guys, this is the worst case scenario here. Anything less than 70 is bad. So hypoglide the brain will die. Now, patient is not alert, only responsive to painful stimuli. So, if they're not awake, we can't ask them to eat. Technically, the patient's sleep. So, we stab them with dextrose IV and then we reassess blood sugar in 15 minutes. Oh, and if you chose option four, shaking my head at you. Question number two, which medication could cause hypoglycemia? Now guys, before you even look at the options, you should already be saying steroids increase the sugar ending in zone like predinazone. So guys, zone ending steroids. Steroids increase the sugar. Now the tricky question number three. The non-diabetic client is admitted for a kidney infection that has now turned septic. The blood sugars have increased from 150 to 225. What is the best answer to give a family member who's asking why insulin is used? So, option number one, the client now has type 2 diabetes. No, that's a wrong answer. Option two, insulin is given to control hypoglycemia. Totally wrong. It's for hyperglycemia. Option three, high sugar is common during infection and stress to the body. And insulin will help lower the sugar until the infection resolves. Guys, yes, option three is the best option. super high sugars. We want to land like a plane, slow and steady. We don't want to crash into that hypoglycemia, that low sugar with low brain function. Now, if you chose option number four, you're nasty. Now, we get many complications from this long-term high sugar where the blood is turned to mud. It's like dumping thick syrup into your blood vessels. And guys, imagine years and years of this. This destroys and scars the blood vessels called atheroscerosis or atheroscarosis and leads to more infections since bacterials love sugar. Ultimately it destroys all the organs. So the kidneys are washing machines that wash the blood. Guys, these guys die which is called nephropathy or renal failure indicated by creatinine over 1.3. So remember enclelex keyword creatinine over 1.3 means injured kidney and also means no more PP. So patients either get a transplant or go on dialysis to wash the blood and nerves die called neuropathy. So patients get loss of sensation and they don't even realize when they get small cuts and injuries on their hands and feet not to mention the sugary blood. So we call diabetic feet delicious treats for bacteria. This leads to infections and slow wound healing and then to amputation and cutting off of those dead feet from all the infections. Now in the eyes the small blood vessels break called retinopathy which leads to blindness. So enclelex key term here guys frequent eye exams are recommended and in the heart we get hypertension from all that high tension on the heart eventually leading to heart disease and then ultimately heart attacks. Lastly in the brain we can have CVAs or strokes from all those narrow blood vessels that either burst from aneurysms or get clots. Now as far as diabetic treatments guys we're going to cover all the diabetic pharmarmacology including the seven rules of insulin. So write these down. These are the most tested. So remember type one we have none or no insulin. The body destroyed the pancreas. So they are insulin dependent for life. And type two the problem is you your diet and a little bit of genetics. So remember type two we have few insulin receptors working. So the first treatment is to fix you your habits. So we focus on diet and exercise to help repair those broken receptors aka increase insulin sensitivity. Then we give drugs like oral meds and insulin but only if diet and exercise don't manage it alone. So for our seven insulin rules, peaks equals plates guys. Typically we give food during a peak since the greatest risk for low sugar is during those insulin peaks. Guys, the number one way to kill your patient is not giving food during the peaks. So know your peak times. During peaks, we monitor for that low sugar, sugar below 70. Now, number two, if you get low sugar below 70, or if your patient looks shaky, or trembly, the classic signs, pale, cool, sweaty, or even clammy, give that patient some sugary candy. The priority key terms again are the A's and the S's. If your patient is awake, ask them to eat. Always sugary food here, guys. So, soda, juices, crackers, and lowfat milk. Not highfat milk or peanut butter, guys. Fat will slow the sugar absorption here. And if they're sleeping, then we stab them with IBD50. Sleeping means unresponsive or unarousable. Responsive only to painful stimuli. So don't just go stabbing sleeping diabetics here, guys. Always assess the sugar and symptoms first. And after you give sugar, always reassess 15 minutes later. We always follow up after any intervention. Always checking the sugar and the symptoms. Now the third rule, insulin with no peaks and no mixes. It's our long acting dudes. Guys, the memory trick is the old dudes. Like grumpy old men who have been here for a long time. They're past their peak and they never mix well with others. They're basically antisocial. So the key words draw up in two separate syringes. So remember, dete lasts all year and glargene is largeing and lantis is like a lantern. It burns all night. Now, number four here, guys, a big Enclelex favorite. They're going to try and trick you. So, the IV only insulin is regular insulin. So, remember our memory trick here. Regular insulin is ready to go IV or regular is right in the vein. Not NPH, not Lispro, not Lantis, guys. No one except regular. He's the VIP for the IV. Now, number five, we draw up insulin. Always clear to cloudy, guys. Just think you want clear days before you want cloudy ones. So draw up regular insulin first, the clear, and then NPH, the cloudy second. Six, we rotate locations every 2 or 3 weeks. And the best location is always on the abdomen. Keywords here, near the umbilicus, naval, or belly button. And guys, we never aspirate. Basically, never draw back on that plunger. It'll cause scar tissue and swelling. And also, we never massage or add heat after subq injections. Now, lastly, number seven, DKA, the extreme high sugar condition in type 1 diabetes, guys. We have a separate video for that. But here's the big ENLEX question here. Do we give insulin on sick days? What if the patient's not eating or basically too nauseous to eat? Well, yes, we give insulin without food. We just monitor that glucose closely. So remember, we always increase the insulin during the S's, like stress, like surgery, sepsis or infection, and even sickness and steroids. For everything you need to know to pass the enclelex, make sure to check out our Enclelex review lecture series and live cram sessions. Now, as far as insulin types who put sugar and potassium into the cells. Now, these are mustnos for the enclelex, specifically the peak times coming up 60% of the time and all endocrine questions. And a little FYI for the ENLEX. Guys, we're not using brand names anymore, only generic. So, no more Novalog or Novalin. If your school is still using this, then they're behind on the times. So again, for reinforcement, our first group is the long acting guys. Our antisocial old dudes, guys. They have no peak and never mix with others. Big ENLEX keyword again, draw up in separate syringes, never mix. These guys have no peaks, so they require no plates or basically they're not food dependent and hence they have a minimal risk for that hypo low sugar. So the brain is pretty safe here. Again, our memory trick here is detrame lasts all year. It's longlasting and glargene is large. Now, NPH are cloudy dude always being mixed. So, remember the ends intermediate insulin and we never give it IV drip or bag. Guys, never put anything cloudy in an IV bag. Now, when we do mix it, always mix clear to cloudy. Clear days before cloudy. So, we usually give NPH two times per day, not four times a day. So, don't let the ANLEX trick you. Now, the peak time is between 4 and 12 hours, but most dangerous in the middle around 5 to 6 hours. So, make sure you have a plate of food with that peak. Next is regular insulin. That's ready to go IV. Guys, again, he's the only dude allowed IV push or IV bag. If you haven't wrote that down, please write it down. His peak is between 2 and 4 hours. So monitor closely for signs of low sugar. That shaky, pale, cool, and clammy. We need to give some sugary candy. Now, finally, our most deadly insulins. They're the number one priority since they have the number one fastest peak and onset. 15-minute onset, guys, with a 30 to 90 minute peak. So, rapid acting insulin. Remember, Lispro, Aspart, and Glacosine. So our memory tricks here for ass part you got to remember to move your ass parts guys it's really fast and lizpro just think less pro less time for the onset it's 15 minutes and glueless it goes fast like a limousine it's super fast so we give these during meals key word here patient is eating or there's food at the bedside again guys patient must be eating in 10 to 15 minutes not before the food's delivered usually an ENLEX question. Those peak times are the mustn knows for the ENLEX. So, I'd recommend printing this study guide out and reviewing it every day the week of your exam. Now, a little insulin quiz. We're covering the top three most tested ENLEX questions on peak times. Here we go. Again, peaks are priorities. The fastest way to kill your patient is not giving a plate of food with the peaks. So, remember peaks require plates. So, we drew a little plate on the flag showing the peak time. Now, our red rapid guides are the most deadly. Always monitor for hypoglycemia, that low sugar below 70. You're gonna see shaky, sweaty, pale, and clammy. So, we give that patient some sweet juice, soda, or candy. Okay, question number one. The nurse gives regular insulin at 12:00 p.m. for lunch, but the patient doesn't finish their food. So, when's the greatest risk for that hypoglycemia? Guys, the risk for regular, look at the peaks right here. 2 to 4 hours. So, if given at 12, the answer is between 2:00 p.m. and 400 p.m. Never before and not after. So, guys, memorize these peak times. Now, question number two. A client is on aspart insulin. When should the nurse advise him to eat? Again, guys, this is an onset of 15 minutes with a peak time between 30 to 90 minutes. So, aspart, guess your asparts moving? The best answer is the soonest. So eating within 10 or 15 minutes. Now question number three. The client on glargene is asking the nurse when is the best time to eat during this insulin. Well guys, glargene is largeing, long acting, no peaks. So no peaks require no plates. Pretty tricky one there. Now for a little bonus question. We saw this a few times in our Enclelex review. So, the client taking insulin NPH with dinner at 700 p.m. What time is the client most at risk for that hypo low sugar? So, NPH has a 4 to 12 hour peak. The most at risk, guys, we're looking at the green peak here. 5.5 to 6 hours has the most peak. So, the best answer here is midnight or shortly after. Now, before we move on to the insulin infusion pump, guys, the best way to memorize these insulin peak times is to print off the study guide or cheat sheet we provide. And guys, write this out at least 7 to 15 times the week of your exam. Now, for insulin pumps or CSI, the continuous subcutaneous insulin infusion, guys, the number one benefit is the steady dose of insulin for our type 1 kids who forget to take their insulin and are basically non-compliant. The biggest benefit and the coolest part here is we have fewer swings in blood sugar level. So not high and not low anymore guys. It's a nice even basil rate. That's a big key word even basil rate. Now how do you manage it? Well we usually check the blood sugar four times per day and you push key word there push an insulin bololis button at meal times to get that sugar into the cell. Now what if you get an enlex question about a machine malfunctioning guys? What do you do? Do you assess the patient or do you assess the machine first? H well, we always assess the patient first and then machine second. Now, that's really big on the ENL. Now, for oral agents, these are only for type two since the body responds to few insulin. Guys, the pancreas isn't dead here. It's just overworked. So, oral agents help to decrease blood glucose and make the body more sensitive to insulin. Kind of like repairing a broken lock. So, we only use these after exercise and diet fail to manage type 2 diabetes. Big key words there, after diet and exercise have failed. Now, in general, we never take oral meds with iron, calcium, and even ant acids that contain calcium. These guys block absorption in the stomach. So, guys, be careful. They're always in over-the-counter pills and medications. Enclelex key word here, OTC, or over-the-counter. Now for our four oral antid-diabetic drugs guys write these down. Metformin or brand name glucapedge, glyphoside, pyogglitazone, brand name acttose and a carbos. Again guys, enclelex will not have brand names only generic. But just in case your nursing exams might still have those brand names. Now the two biggest things to write down. We avoid alcohol and liver disease patients since these drugs can be toxic to the liver. Now first on the list is metformin from the class of binguanides. So guys think big guys like you met for men in metformin. They reduce the output of glucose by the liver and also increase insulin sensitivity. Now that's not usually on the enlex but the M's of metformin are. So remember this, minimal chance of hypoglycemia, that low sugar, major liver and kidney toxic. And lastly, we always hold 48 hours before cath lab since contrast kills the kidneys and leads to lactic acidosis. So guys, hold metformin with cath lab. Okay, now hold your horses here. A little enclelex tip and side note. When metformin is not taken, the patient is switched to a sliding scale for insulin, but only temporarily. Now, this is typically done before and after a CT scan or anything with contrast die. Also, during pregnancy and if the client is NPO for something like surgery. So, we say this because it's commonly tested. So, I'd be sure to write that down. And a little side note about the kidneys. Creatinine over 1.3 usually means an injured kidney. And urine output 30 mls per hour or less usually means the kidneys are in distress. Next is sulfanura class. These guys stimulate the pancreas to release insulin. And they end in eyid like glyphoside or glyberide and they're very bad for the heart. So think eyid. The heart may die guys. It's very bad for heart failure and MI history. Big key words there. Now caution guys. The enclelex and your exams are going to try and trick you with a suffix guys. Other eyed ending drugs like ferosemide a diuretic the body is dried or isorobide is a vasoddilator. So our memory trick is the G's are for glucose. So glyphoside and glyberide and the Fs like ferosomite are for fluids that are dried and the O's for isorbide are the O's for vase O dilator. Now just like metformin they also have a mini chance of low sugar or hypoglycemic events and they also cause massive weight gain. So again guys clients will not lose weight, they're actually going to gain it. And lastly, they also may cause sunburn. So we use sunscreen and protective clothing. Oh, and they're also toxic for our elderly patients. So metformin is always our first choice. Next is pyaglitazone hydrochloride which reduces insulin resistance ending in own like thioladine dione. So think the own or the one as one dead heart. It's very heart and liver toxic and a huge risk for heart failure. So again, heart failure means heavy fluid retention. Key words here, new pitting edema, worsening crackles in the lungs, and rapid weight gain, which usually means water gain. Now, last and definitely least, since this guy is not really common on the ENLEX, alpha glucosidase inhibitors ending in o like a carbos and priose. Guys, they rhyme with gross since they cause massive flats or farts and diarrhea. These guys are carb blockers. They break down carbs and decrease glucose. Basically, digest food for you, but not given to IBS, irritable bowel syndrome patients. Now, as far as patient education for diabetes, we use the two D's. D for diet that's low in sugar and low in simple carbs and D for diabetic feet, which we call delicious treats for bacteria. So the top Enclelex tips for diet. Key word here is the lows. Low calories and low simple sugars. We avoid simple sugars with no fiber guys. So soda, candy, white bread, white rice, and even juices. The goal is we want wellbalanced meals with enough protein and fats, high fiber carbs, guys. These are good. So good carbs are the high-fiber complex carbs. Typically key words are brown or whole. So brown beans, brown rice, brown bread, guys. Not white bread and not white rice. Bring it down to brown town. Now the next key word, whole. So the whole grains, the whole wheat, and even whole milk. All these include high fat. And even peanut butter has high fat. This helps slow the sugar absorption. Now these are called our low glycemic index foods. So just think fiber slows the digestion of sugar. But caution here, guys. The number one offender are fruit juices, which are usually very sugary since they took out the pulp, which had the fiber in the fruit. Now, second, we avoid those bad carbs with low fiber that hits the bloodstream super quick, aka high glycemic or simple carbs. And you already know these carbs, it's the ones we love to eat. Typically, anything white or sweet. So, white bread, white rice, white pastas, even French fries, and deep fried anything, guys. And even lowfat milk. And also here, big keyword, fruit, juices. And you already know the typical junk food. Candies, sodas, chips, and donuts. You know, all the normal nursing student stuff. Oh, wait. What? This? Oh, come on, man. This all I could afford after my tuition. I mean, I I could be having a treatment. You never know. So, we teach clients to avoid these bad carbs during normal everyday life. But guys, during low sugar crisis, like the sugar is less than 70, that's when it's okay. Now, for your third test tip, what if you get a blood sugar of 60 or less in the A.M., guys, we always tell patients to eat a bedtime snack. And guys, the fourth thing is therapeutic communication. Guys, these are always the weirdest questions on the ENLEX. So, they'll give you a totally awkward situation. Then they'll ask, "How should you, the nurse, respond?" And guys, to be honest, there's only two options here. Either we ask more questions like, "How do you feel?" or "How does that make you feel?" Or you just be supportive. Guys, never ask why. Never use words that judge, accuse, or put the patient down. So guys, use common sense. Don't be a jerk or an idiot. Don't be an idiot. Now, we don't want patients to feel bad. So not victimized, not dependent, not helpless or sacrificed. So guys, yes, be supportive and educate that patient. So yes, capable, yes, independent, and yes, in control and managed. Those are the goals. And lastly, number five, fasting for religious reasons. The patient is going on vacation and plans to fast or plans to drink alcohol. Guys, the number one thing we do as a nurse is always assess the patient, not the family or machines. So we always assess first. We ask, we analyze and we evaluate. Then we intervene. Keywords for that are give, administer, implement, educate, refer, or even advise. Now, in this case, what's going to kill the patient? Well, what's going to kill them is the low sugar below 70. Remember, hypoglide, the brain will die. So, assess compliance, guys. We're assessing labs, med compliance, even history of blood sugar episodes like high and low sugars and even extreme episodes like those DKA and HHS. So, we always assess first and intervene second by teaching. Guys, in this case, we're teaching the patient to avoid dying from that low sugar by always recognizing the shaky, cool, and clammy. We're giving the patient some soda, juice, low-fat milk, or some sugary candy. We're going to try to avoid that low sugar below 70 to avoid that low brain from dying. Now, as far as diabetic feet, just think delicious feast for bacteria. Guys, bacteria will feast on all that sugar. So, open sores will lead to infection, which eventually leads to amputation. Therefore, foot protection is huge, guys. We have to love those toes. So, the goal is CDI. and collect key words clean, dry, and injuryfree. Not harsh, not rough or damaging. Be gentle, be soft, be loving. So, use our acronym foot for things to avoid. F for flip flops, high heels, and nylon. Guys, no sandals, no bare feet, no high heels, so you're not getting fancy. And definitely no nylon. But yes, for soft cotton, clean and absorbent socks, clean and dry is the goal. So, big key words to know for the Enclelex, closed toed shoes, comfortable, supportive, well-fitting, and sturdy. Oh, and also leather shoes. Guys, we have to love those feet and protect those feet. Now, avoid O for over- the-counter corn removal. Now, usually for the Enclelex, anything over-the-counter is usually always a big no no for the Enclelex. typically the wrong answer. Next O is for overly hot baths and pads. So no hot pads and no hot baths. Guys, patients have dead nerves and can't feel how hot the water actually is. So key words here, always use a thermometer to test the temperature. Never a hand. Thermometer, guys, testing the temperature since again the loss of sensation in the hands and feet from that neuropathy, those dead nerves. And lastly, T is for toe injuries. Probably the biggest one here. So, listen up. Daily inspection. Never weekly, always daily. And immediately report any injury to the HCP or basically the doctor. Now, remember, diabetic feet are delicious treats for bacteria. Open sores get infected very quickly, leading to amputation. And another big one here is the toenails. Big key words, cut straight and file the edges. And I can already see this coming up as a question. Never cut at angles. Always cut straight. And in the hospital, only doctors can cut those nails. Never nurses. Now, after shower, always dry between the toes using soft cotton towels, guys. Clean, dry, and soft. Enclelex. Key word here. Separate the toes to dry. And yes, oil on the feet is okay. Now, again, the big no no list. No callus removal, no heavy powder, but light is okay. And no rubbing the feet hard or vigorously. Love those feet and be gentle, clean and dry. Now you will get a select all that apply question about feet. So to help you practice, let's do this question. Which statement by the patient with diabetes, big key word there, indicates correct understanding? So option number one, I will get comfortable fitting sandals. No guys, no sandals. How about two? I will test the bath water with my fingers before getting in. No, we always use a thermometer. I will get routine pedicures for my callus, but not rub vigorously, guys. No, never callous removal. How about option number four? I will use leather shoes with cotton socks. Awesome. Two big key words. Leather shoes, cotton. I will assess feet weekly. No, no, no, no, no. always daily. And the last one, I will cut my own nails at angles but file the edges. No, guys, we always cut straight across, but yes, we do file the edges. Thanks for watching. Did you know you can unlock beautifully handcrafted study guides? A packed with key points and memory tricks from all our videos. Plus, you'll get access to over 1,200 exclusive videos not on YouTube, all neatly organized by nursing school topic. to make that complex nursing knowledge actually stick. You'll also gain thousands of practice questions written by current professors and actual ENLEX writers. So, for access to all this and more, click right up here or visit simple nursing.com. And don't forget to subscribe to our YouTube channel. Happy studying and we'll see you in the next videos.